Review: Mental Health and Social Isolation among Sub-Saharan African Migrants in Tunisia: A Cross-Sectional Quantitative Study {under peer review}

 

Reviewer: Hanna Denysenko

 

Completed: 18-09-2025 17:38

 

Recommendation: Resubmit for Review

 

 

	Yes	No	N/A
Is the research question clearly defined?		+
Are the methods appropriate and sufficiently detailed?		+
Is the data analysis robust and replicable?		+
Are the conclusions supported by the results?		+
Is the manuscript well organised and clearly written?		+
Are tables, figures, and supplementary material informative and necessary?		+
Is the abstract an accurate summary of the study?	+
Does the manuscript contribute meaningfully to the field?		+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

General Assessment

This manuscript raises the relevant issue of the impact of migration on the mental health of individuals from North Africa traveling to Tunisia.

The topic is of interest as it combines such problematics as migration, social isolation, and psychological distress. The work is presented in the form of descriptive data. The conducted analysis may be considered as a foundation for future research on migration, social isolation, and mental health.

However, the methodological basis—such as sample size, strategy, design of reviewer selection, and adaptation of research instruments—raises concerns regarding the strength of the conclusions. At this stage, the work is presented more as an exploratory sketch, a basis for future studies, rather than as confirmatory research.

Major Concerns

 

Literature Review (Introduction). The author analyzed literature relevant to the subject of the study, particularly relying on migration statistics in Tunisia (UNHCR, 2024; Global Initiative, 2024), which add topicality to the research theme. At the same time, the relevant population was not analyzed in depth, which gives the work a generalized character. When using established theories, the author refers to Engel’s (1977) biopsychosocial model, but it is not linked to hypotheses and research questions. The manuscript also shows only a superficial connection to Berry’s (1997) acculturation theory and Nguyen et al. (2024). While employing constructs such as “social isolation” and “acculturative stress,” the author does not provide a critical analysis of how the concept of acculturation has been redefined in the context of contemporary empirical research, which reduces the analytical depth of the study. The review requires greater clarity and more specific analysis. The author should focus on systematic evidence from studies on migration psychology and acculturation, clearly identify variables and hypotheses based on the selected theoretical models, and demonstrate the novelty of the work beyond its geographical scope.

Research Objectives. The objectives are not clearly formulated and not aligned with the analyses. First, the objectives are overly ambitious for a local field study and need to be narrowed and specified. For example, the aim “to explore intersecting relationships” lacks clarification as to which specific models are to be tested. The objectives regarding age, gender, and “transit status” as factors are not aligned with the analysis. The goal of analyzing the role of the transit context in measuring acculturation factors has not been fully achieved. The manuscript should include a dedicated section with research questions and hypotheses and their connection to empirical and statistical data.

Methods. The author employs a cross-sectional quantitative design, which allows for a quick snapshot of the sample. However, the criteria for forming the sample are unclear, and no acculturation measures are provided. It is not explained why the interview method was chosen, whether it is optimal for achieving the stated objectives, or what limitations it entails. The chosen methods do not account for migration history, physical and mental health, or differences in responses depending on country of origin. No information is provided on standardization procedures: whether the author personally conducted the interviews or used interpreters, which may create a risk of bias. The issue of a control group is entirely ignored.

Measurement Validity. The author applies a cross-sectional quantitative design in the form of face-to-face interviews. While convenient for fieldwork in this context, it has substantial limitations. First, cross-sectional design does not allow causal conclusions. An unclear sampling strategy (convenience, time-location sampling) produces non-representative results. Second, although the author states that “standardized composite scales” were used, he also notes that he edited the questions and reduced the list to six items, which threatens validity. Third, the absence of cultural adaptation weakens measurement reliability. The author should employ more robust, validated, multidimensional instruments that take into account cultural specifics of the region and preferably adopt mixed-method or longitudinal approaches.

Statistical Analysis. The analysis shows some useful descriptive results but does not confirm the scope of the stated objectives. Prevalence and intensity of symptoms are only partially assessed. The author reports mean values of depression, anxiety, and social isolation but interprets them as “high prevalence” without diagnostic cut-offs, complicating comparison with normative data. To examine direct and intersecting relationships, only Pearson’s correlation between social isolation and depression is presented; no regression models are provided. T-tests and ANOVA for demographic and contextual factors are non-significant; multivariate regression with controls for education, age, etc., is recommended. Age differences are insufficiently analyzed. In the cluster analysis, the small, non-representative sample undermines validity. Thus, ambitious conclusions such as “high prevalence” and “clinical profiles” are not statistically supported. Descriptive statistics presented as evidence of prevalence and significance cannot serve as the basis for main scientific conclusions.

Recommendations. Specify constructs more precisely, increase the sample size, introduce a control group, include acculturation measures (language, migration history, ethnicity, social environment/culture). Replace univariate tests with MANCOVA. Provide comparative data with normative samples (population means, etc.).

Results and Discussion. The stated aims and objectives are not fully supported by statistical data. Data description and interpretation are not clearly distinguished, creating risks of false conclusions. The absence of a control group and validated cut-offs threatens the scientific significance of the study. The discussion is superficial and does not take into account regional acculturation research. The author should avoid generalizations and base conclusions strictly on the data presented.

Conclusion. The study raises the important issue of the psychosocial vulnerability of Sub-Saharan migrants in Tunisia. However, the author should improve the literature review, justify the methods, reconsider the validity of instruments, expand the sample, and align description with interpretation. After revision, this study could become a valuable contribution to the literature on migrant mental health in North Africa.